AUTHOR=Mamode Nizam , Bestard Oriol , Claas Frans , Furian Lucrezia , Griffin Siân , Legendre Christophe , Pengel Liset , Naesens Maarten 

TITLE=European Guideline for the Management of Kidney Transplant Patients With HLA Antibodies: By the European Society for Organ Transplantation Working Group

JOURNAL=Transplant International

VOLUME=Volume 35 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10511

DOI=10.3389/ti.2022.10511

ISSN=1432-2277

ABSTRACT=The proportion of highly sensitized patients presenting for transplantation is increasing. Sensitization should be defined using a virtual parameter such as CRF, and solid phase assays should be standardized. Highly sensitized patients (HSP), defined as a CRF of >85%, should be prioritized in kidney allocation schemes. Linking allocation schemes may increase opportunities for HSP. The use of the ENGAGE 5 system and only calculators for assessing risk is recommended. The use of the Eurotransplant Acceptable Mismatch Scheme should be extended. Desensitization should be performed with plasma exchange or immunoadsorption, supplemented with IViG and/or anti-CD20 antibody. Newer therapies, such as imlifidase, may offer alternatives. Very few studies compare HLA incompatible transplantation (HLAi) with remaining on the waiting list- there is no disadvantage to HLAi. Comparisons of morbidity or quality of life do not exist. Kidney sharing schemes should be more widely used and should include unspecified (non-directed) and deceased donors, as well as compatible pairs. The use of a sharing scheme is preferred to desensitization, but HSP should not be left in a kidney sharing scheme indefinitely if the option of a direct incompatible transplant exists.